title: Evaluation of antiretroviral-related errors and interventions by the clinical pharmacist in hospitalized HIV-infected patients.
abstract: OBJECTIVE
  The aim of the study was to identify antiretroviral-related errors in the prescribing of medication to HIV-infected inpatients and to ascertain the degree of acceptance of the pharmacist's interventions.
  
  
  METHODS
  An observational, prospective, 1-year study was conducted in a 750-bed tertiary-care teaching hospital by a pharmacist trained in HIV pharmacotherapy. Interactions with antiretrovirals were checked for contraindicated combinations. Inpatient antiretroviral prescriptions were compared with outpatient dispensing records for reconciliation. Renal and hepatic function was monitored to determine the need for dose adjustments.
  
  
  RESULTS
  The prescriptions for 247 admissions (189 patients) were reviewed. Sixty antiretroviral-related problems were identified in 41 patients (21.7%). The most common problem was contraindicated combinations (n=20; 33.3%), followed by incorrect dose (n=10; 16.7%), dose omission (n=9; 15%), lack of dosage reduction in patients with renal or hepatic impairment (n=6; 10% and n=1; 1.7%, respectively), omission of an antiretroviral (n=6; 10%), addition of an alternative antiretroviral (n=5; 8.3%) and incorrect schedule according to outpatient treatment (n=3; 5%). Fifteen out of 20 errors were made during admission. A multivariate analysis showed that factors associated with an increased risk of antiretroviral-related problems included renal impairment [odds ratio (OR) 3.95; 95% confidence interval (CI) 1.39-11.23], treatment with atazanavir (OR 3.53; 95% CI 1.61-7.76) and admission to a unit other than an infectious diseases unit (OR 2.50; 95% CI 1.28-4.88). Use of a nonnucleoside reverse transcriptase inhibitor was a protective factor (OR 0.33; 95% CI 0.13-0.81). Ninety-two per cent of the pharmacist's interventions were accepted.
  
  
  CONCLUSIONS
  Antiretroviral-related errors affected more than one-in-five patients. The most common causes of error were contraindicated or not recommended drug-drug combinations and dose-related errors. A clinical pharmacist trained in HIV pharmacotherapy could help to detect errors and reduce the duration of their effect.
authors.affiliation: Department of Pharmacy, Hospital Clinic, Barcelona, Spain. ecarcelero@yahoo.es
authors.forename: E
authors.initials: E
authors.lastname: Carcelero
authors.forename: M
authors.initials: M
authors.lastname: Tuset
authors.forename: M
authors.initials: M
authors.lastname: Martin
authors.forename: E
authors.initials: E
authors.lastname: De Lazzari
authors.forename: C
authors.initials: C
authors.lastname: Codina
authors.forename: J
authors.initials: J
authors.lastname: Miró
authors.forename: Jm
authors.initials: J
authors.lastname: Gatell
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006784:Hospitals, Teaching; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D054539:Medication Therapy Management; D008875:Middle Aged; D019370:Observation; D004364:Pharmaceutical Preparations / Q000592:standards; D010595:Pharmacists / Q000523:psychology; D010607:Pharmacy Service, Hospital / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies
chemical_list: D000998:Antiviral Agents; D004338:Drug Combinations; D004364:Pharmaceutical Preparations